State v. Smith

144 So. 3d 867, 2014 WL 341007, 2014 La. LEXIS 201
Supreme Court of Louisiana·Decided January 28, 2014·No. No. 2013-KA-2318·Published·Cited by 5 cases

Opinion

VICTORY, J.

| ,This case comes to us on direct appeal pursuant to La. Const, art. V, § 5(D)(1) after a district court found La. R.S. 14:126.3.1(A)(3), pertaining to the unauthorized participation in medical assistance programs, facially unconstitutional. After reviewing the record and the applicable law, we reverse the judgment of the district court and uphold the constitutionality of La. R.S. 14:126.3.1(A)(3).

FACTS AND PROCEDURAL HISTORY

On February 23, 2012, Micah Smith was charged in the 19th JDC with a violation of La. R.S. 14:126.3.1, which provides:

A. A person commits the crime of unauthorized participation in a medical assistance program when the person has been excluded by any state or federal agency under the authority of 42 U.S.C. 1320a-7, LAC 50:4165, or LAC 50:4167, and knowingly:
(1) Seeks, obtains, or maintains employment with a provider.
(2) Seeks, obtains, or maintains employment as a provider.
(3) Seeks, obtains, or retains any monies or payments derived in whole or in part from any state or federal medical assistance funds while excluded from participation in any state or federal medical assistance program.
(4) Seeks, obtains, or maintains a contract with a provider.
|2(5) Shares in the proceeds from a provider or participates in the ownership or management of a provider.
[869] B. The following definitions apply to the terms in this Section:
(1) “Exclusion” means that a state or federal oversight agency has determined that the person or provider can no longer be employed by, contract with, or have an ownership or management interest in any entity that provides services which will be billed directly or indirectly to any medical assistance program.
(2) “Medical assistance program” means any state or federally funded program paid for directly or indirectly with federal or state funds.
(8) “Oversight agency” means the state or federal agency responsible for the administration of the medical assistance program, including but not limited to Louisiana’s Department of Health and Hospitals or the United States Department of Health and Human Services, office of the inspector general.
(4) “Participation” means employment for a provider in any capacity, employment as a provider in any capacity, or obtaining any monies derived in whole or part from any medical assistance programs.
(5) “Payment” includes a payment, any portion of which is paid out of any medical assistance program funds, including but not limited to the Louisiana Medicaid Program. “Payment” also includes a payment by a contractor, subcontractor, or agent for the Louisiana Medicaid Program, or any other state or federally funded medical assistance program pursuant to a managed care program, which is operated, funded, or reimbursed by the Louisiana Medicaid Program, or any other state or federally funded medical assistance program.
(6) “Provider” means an actual provider of medical assistance or other service, including any managed care organization providing services pursuant to a managed care program operated, funded, or reimbursed by any state or federally funded medical assistance program, including but not limited to the Louisiana Medicaid Program.
C. Whoever commits the crime of unauthorized participation in medical assistance programs shall be:
(1) Imprisoned for not more than six months or fined not more than one thousand dollars, or both, when the state or federal exclusion is based on an underlying criminal conviction defined by Louisiana law as a misdemeanor, or when the exclusion is based on any reason other than a criminal conviction.
(2) Imprisoned for not more than five years with or without hard labor, or fined not less than one thousand dollars nor more thanjjtwenty thousand dollars, or both, when the exclusion is based on an underlying criminal conviction defined by Louisiana law as a felony.

Added by 2009 La. Acts. 337, eff. July 1, 2009.

Specifically, the state alleged:
On or about March 10, 2010, through and including the present, 2012, Micah Smith, defendant herein, committed the crime of Unauthorized Participation in a Medical Assistance Program in that he, after being excluded by any state or federal agency, he knowingly: Seeks, obtain, or maintains employment as a provider; Seeks, obtains, or retains any monies or payments derived in whole or in part from any state or federal medical assistance funds while excluded from participation in any state or federal medical assistance program; and Seeks, or maintains a contract with a provider in violation of La. R.S. 14:126.3.1.

The state alleges in its brief that it expects to prove at trial that Micah Smith [870] was excluded from participating in medical assistance programs through the administrative process by the Louisiana Department of Health and Hospitals (“DHH”) for various allegations of fraud and misconduct. Among other things, DHH administers the Louisiana Medicaid Program. After that exclusion, Smith continued to serve as the billing agent for Medicaid providers, despite his exclusion.1

On February 4, 2013, defendant filed a motion to quash in which he challenged La. R.S. 14:126.3.1(A)(4) (“Seeks, obtains, or maintains a contract with a provider”) as overbroad because it would “prohibit a substantial amount of free speech and actions which would be protected under the First Amendment.” It is apparent that this provision was intended to prevent a person who is excluded from being employed by, contracting with, or having an ownership or management interest in, any entity that provides services which will be billed to any medical assistance program, from contracting with a provider of such services in order to continue to profit thereby. However, defendant argues that it goes too far in | ^prohibiting any contractual arrangement between an excluded person and a Medicaid provider, which “can run the gamut from cutting a provider’s grass, to cleaning their home or office, to cutting their hair, or selling them insur-anee.” Therefore, defendant contended that the enactment prohibits a substantial amount of protected speech and the freedom to associate and is thus overbroad. In opposition, the state argued that contractual freedom is not constitutionally protected speech as contemplated by the overbreadth doctrine.

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State v. Smith, 144 So. 3d 867, 2014 WL 341007, 2014 La. LEXIS 201 (La. 2014).

144 So. 3d 867 (State v. Smith) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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